Contact modality and contact intensity over time among community health workers in adult sickle cell disease Free

Background The effectiveness and efficiency of medical center-based Community Health Workers, also known as Patient Navigators (PNs), in chronic disease care lies not only in their presence but also in their mode of patient engagement. In adult sickle cell disease (SCD), PN contact methods must evolve to meet evolving program needs, in order for them to remain effective and maximally available. Understanding PN changes in contact modalities and time intensity could offer insight into more efficient resource use, could suggest program adaptations to incorporate new technologies, and could give insights on adapting to urgent changes in patient needs, such as those that arose during the COVID-19 pandemic.

Methods We retrospectively analyzed contact types and durations recorded by PNs in an adult SCD medical home from 2018 to 2024. Contact types were categorized as inpatient, outpatient clinic, phone (live or voicemail), telemedicine, text messaging, community visit, home visit, email, and patient-initiated contacts. Metrics included total number of contacts per category per year and average time (in minutes) per contact type annually. This analysis explored annual numeric shifts in the frequency and time intensity by contact modality over the 7-year period. No formal statistical comparisons of yearly trends over the 7 years were conducted, since populations being managed shifted each year, and adjustments for differences across years were not practical.

Results In 2018, inpatient encounters were the most common (382). These contacts steadily declined to 31 by 2024. Meanwhile, telephonic and text-based communication expanded dramatically: phone/telemedicine contacts rose from 275 in 2018 to 483 in 2024, while text message contacts increased from 117 to 534 over the same period. Average time per contact also shifted: phone/telemedicine time rose from 12.1 minutes to 82.5 minutes, and text message duration increased from 10 minutes to 94.9 minutes. Outpatient clinic visits rose from 107 in 2018 to 464 in 2024, averaging 31–56 minutes per visit. Community visits and patient-initiated contacts were the most time-intensive, with community encounters peaking at 235 minutes per contact in 2022 and patient-initiated contacts remaining above 70 minutes from 2020 onward.

Conclusion Confounded by the differences in annual population characteristics for each of the 7 years we studied, we believe the numeric annual trends we report illustrate a meaningful transformation in patient navigator engagement strategies—from an inpatient-focused, reactive model to a proactive, outpatient-driven, and digitally supported approach. Collectively, the data reflect a shift toward a hybrid care model that prioritized outpatient and remote engagement, while preserving the ability to offer deep, flexible support when needed. Texting, phone, and telemedicine became core tools of engagement, suggesting more substantive or multi-message interactions, enabling scalability without sacrificing depth. Increased time per contact in remote modalities reflected adaptation to complex needs, longer touchpoints, and richer content delivery. Meanwhile, the decreasing reliance on inpatient contacts suggested either high patient familiarity of a mature program, and thus less need for face-to-face contact, versus improved continuity and upstream intervention. These findings underscore the importance of a flexible, hybrid in-person versus virtual patient navigation model capable of matching contact type and intensity to patient complexity. Our data offer a blueprint for other chronic disease programs aiming to optimize both reach and high-touch, relational care.